Coughing up blood is the spitting up of blood or bloody mucus from the lungs and throat (respiratory tract).

Hemoptysis is the medical term for coughing up blood from the respiratory tract.

Coughing up blood is not the same as bleeding from the mouth, throat, or gastrointestinal tract.

Blood that comes up with a cough often looks bubbly because it is mixed with air and mucus. It is usually bright red, although it may be rust-colored. Sometimes the mucus may only contain streaks of blood.

A number of conditions, diseases, and medical tests may make you cough up blood.

Diseases and conditions may include:

• Blood clot in the lung
• Bronchiectasis
• Bronchitis
• Cancer
• Cystic fibrosis
• Goodpasture's syndrome
• Inflammation of the blood vessels in the lung (vasculitis)
• Inhaling blood into the lungs (pulmonary aspiration)
• Irritation of the throat from violent coughing
• Nosebleed that drips blood down into the lungs
• Laryngitis
• Pneumonia
• Pulmonary edema
• Systemic lupus erythematosus
• Tuberculosis

Diagnostic tests that can make you cough up blood include:

• Bronchoscopy
• Laryngoscopy
• Lung biopsy
• Mediastinoscopy
• Spirometry
• Tonsillectomy
• Upper airway biopsy

Cough suppressants may help if this condition is due to throat irritation from violent coughing. However, cough suppressants may lead to airways obstruction in some cases. Always check with your doctor before using them.

It is very important to note how long you cough up blood, and how much blood is mixed with the mucus.

Also look out for these signs of severe blood loss:

• Dizziness
• Light-headedness
• Thirst

Other symptoms:

• Blood in the urine
• Chest pain
• Fever
• Shortness of breath

If you have any unexplained coughing up of blood, call an ambulance or go to the nearest emergency department. This is very important if your cough produces large volumes of blood (more than a few teaspoons), or if you also have:

• Dizziness
• Light-headedness
• Severe shortness of breath

In an emergency case, your doctor will give you treatments to control your condition. The doctor will then ask you questions about your cough such as:

• Type
  • Are you coughing up large amounts of blood (massive hemoptysis)?
  • Can you see blood when you cough up something?
  • How many times have you coughed up blood?
  • Is there blood-streaked mucus (phlegm)?

• Time pattern
  • Did it begin suddenly?
  • Has it increased recently?
  • How many weeks has the cough lasted?
  • Is the cough worse at night?
  • What other symptoms do you have?

The doctor will do a complete physical exam and check your chest and lungs. Tests that may be done include:

• Bronchoscopy
• Chest CT scan
• Chest x-ray
• Coagulation studies, such as PT or PTT
• Complete blood count
• Lung biopsy
• Lung scan
• Pulmonary arteriography
• Sputum culture and smear

Hemoptysis; Spitting up blood; Bloody sputum

Rakel RE. Textbook of Family Practice. 6th ed. Philadelphia, Pa: WB Saunders; 2005:402-413.

Murray J, Nadel J. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:497. 

Updated by: Andrew Schriber, M.D., F.C.C.P., Specialist in Pulmonary, Critical Care, and Sleep Medicine, Virtua Memorial Hospital, Mount Holly, New Jersey. Review provided by VeriMed Healthcare Network.